Age-specific patterns of lymph node involvement in elderly patients with oral squamous cell carcinoma: a retrospective cohort study

OBJECTIVES: Age-related alterations in lymphatic and immune function may influence nodal disease patterns in elderly patients with oral squamous cell carcinoma (OSCC). This study aimed to evaluate the association between chronological age and lymph node metastasis (LNM) and to assess whether the lymph node ratio (LNR) retains prognostic relevance for overall survival (OS) across different elderly age groups. MATERIALS AND METHODS: This retrospective cohort study included 363 patients aged ≥ 65 years who underwent primary surgical treatment for OSCC. Age was analyzed both as predefined age groups and as a continuous variable using natural cubic spline modeling. Associations between age and LNM were examined using logistic regression. The impact of age and LNR on OS was evaluated using Cox proportional hazards models, supplemented by time-dependent receiver operating characteristic analyses. RESULTS: Chronological age showed no significant linear association with LNM, while spline analyses indicated only a weak non-linear relationship. Higher comorbidity burden was inversely associated with LNM. LNR was not correlated with age and showed comparable distributions across elderly age strata. In survival analyses, LNR demonstrated a strong non-linear association with OS, whereas age exerted only a modest effect. Overall survival did not differ significantly between elderly age groups. CONCLUSIONS: Chronological age alone was not a major determinant of nodal involvement or survival in elderly OSCC patients. LNR remained a robust prognostic indicator independent of age. CLINICAL RELEVANCE: LNR may aid in risk stratification and postoperative decision-making in elderly OSCC patients, supporting individualized oncologic management beyond chronological age alone.